9904-114 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 -(commencing with Section 7000) of Division 3 of the Business and
Professionals* Code, and my License is in full force and effect.
Licensee {' � Lic. Class Exp. Date
316
,/Date tSignatureof.ContractorA����^� '
�/.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law fmthe following reason:
(' " as owner of the property, or my employees with wages as their sole
compensation,,will do the work, and the structure is not intended or offered for
sale,(Sec. 7044, Business & Professionals Code).
( ) I, as owner of 'the property, am exclusively contracting with licensed
contractors, to construct the "project (Sec. 7044; Business & Professionals
Code).'
( )'• I am exempt under Section B&P.C. for this reason
Date . Signature of Owner '
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(. ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the. Labor Code, for the
performance of the work for which this'permit is issued.
() 1 have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is "issued. My,workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
ME P
(This Section need not be completed if the permit valuation is for $100.00 or less).
(.) I certify that in'the performance of the work for which this, permit is issued,
I 'shall not employ any person. -in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should' become
subject to the workers' compensation provisions of Sectio 3700 of/the Labor
Code,1 s all fortMbh comply with'those<proviisions. rr,
/Date:' `"� Applicant i_.-.��..: •( /
Warning: Failure to secure Workets',Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT -,Application is -hereby made to, the Director of Building and Safety
or. a 'permit subjbcf to the conditions and restrictions set forth on his
application. '
1. -Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under.or pursuant to
any, permit issued as a result of this applicaton agrees to, & shall, indemnify
&.'hold harmless the City of. La Quinta, its officers, agents and employees.
.2. Any permit issued as a result of this application becomes null and void if
Work is, not commenced within 180 days. from date of issuance of such
t per `mit , or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct..l agree to comply with, all City, and State laws relating to the building
cystruction, and hereby authorize4representatives o(this City to enter upon
t e above -menti
oned property"for inspection
}purposes.
' f .c�Rif /^i.�"^ Date il/l-/1 ! i
Signature (OwnedAgent) ��
BUILDING PERMIT PERMIT#
DATE, rr� VALUATION LS -1,41.248,40 LOT 1 TRACT N-1158-1
JOB SITE t ►
ADDRESS 7&5.2,5 T011046 DRIVE,
APN ��p
OWNER
CONTRACTOR/DESIGNER/ENGINEER
�ht' 1+70i3ti1%a.v ii�.is�*
!i'�-�W0'���.i.�>Ghv.i�.u)e.�ii�ia
",13 NjWiXg DR
i+°�'NCi:i.yiV4,:f'i;FS 1A1"vE
LA. QUINTA. C.'A 92253
LA. (;rJWFA. CA -9225:3
USE OF PERMIT
a`iN(. LR, #°M'11 .Y .T.i1+�Eg..L,iNG.
i&IUL;l'itPIX' l: SWUANC 8Ot, SAIVfE?.'?#:A.Pf TYPU., VIAS ,M r W115 NCYf 1NC1.1WH
fit t: X W.ALL OR, PO (, -)L.
TRACT CO?d',:a 1':1di;C"1'KIN Z400.00 33'
POR.G°f•tlPATIO( ➢.50.00 SF
OAKFlCi}?Jt`A#.(('471(.:1' 449.00 St?
;x*,a{T.INIM' T.) MIT OF MNI S FRUM. ON
141,243.413
PERMIT PKE fiUMIMARV
CONSTRUCTIOIN FW 101-000 418.OQO $786.3*s
PLAN C'MMM. 111:1,./1t{(ti 42'x-llR $16L98
NIECHANUCAL FVX: 560,00
Fill C'1'id.tCAL FEE 101 -000420 -OW 5141,48
X�L;t711�£11tdC•1�3k: lUl ••AC1SD-4!' �3-i)(1U �l.46.'Y5
'3ThONcl?lA'f,1'itON1l;E-ILLS)) 1014011-24.1-1)00
GRADING F'E7: 1014=142-x_000 �21►.04
T14FRASTRUCTURE F M 225-000-M-1.342
Are.T IN PUBLIC PLAQ:'Wi-11kLS1iti 71114)00-25S-000 $1013.12
SUB T01' L C N8717 c,fC'•'i�O.N -ANT) PLAN[ 6:'KC:K
g4,5� iR
LESS PRE P UD HES
1,11011:
,! 4J•.3. t'l3A .4 E17]r1'IVI P 6'. ES DUC NO W
.$4,558.16
RE E PT
DATE ��
BY ((j u
DATE FINALED
INSPECTOR
M
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
f. . BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck Q
Exhaust Fans
O.K. to Wrap (�
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
-
Gas Test -/ I 220 52a
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground, Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub.Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)_
COMMENTS:
4p%
4p%
MOV-05-99 FRI 1.0:53 WESTERN INS1ULATION FAX NO. 9096868786•
P.11
WEST
i
4211 Lath= Street, Rhemide, Califorab 92501
f
• t�os) ea6s�r�
� ,
(909) d!l6.8786 Fax
,
lNiMT CERTIFICATE,
`
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE.,
WITH THE-
CU ' RRENT ENERCY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF
CAIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: BELLA VISTA-PHASE 513 TRACT #: 28458-1'.
LOT#: 10
SITE ADDRESS: 78525 TORINO DRIVE, LA QUINTA, CA.
y
EXTERIOR WALLS; -
NOTE:OFFICES f
a
MANUFACTURER:, JOHNS-PrIANVILLE THICKNESS: 35/8 R-VALUE;
R-13
CEILINGS=;. ArrS BLOW
-
y MANUFACTURER: JOHNS-MANVILLE THICKNESS: 1:3" R.-VALUE:
R-38
CEILING A BATTS BLOW
{ MANUFACTURER: - GREENSTONE THICKNESS: 10.3" R-VALUE:
R-38 •
GENERAL CONTRACTOA;_ ROGER SNELLENBERGER
' .LICENSE NUMBER:
.� BY:
`TITLE:`
r
DATE•
INSULATION CONTRAC'LOR: WESTERN INSULATION, INC., .
LICENSE NUMBER: 481278
BY:
TITLE: Pr uetidn
. na r I•
'DATE:. .`NOVEMBE 5;1999
ROGER SNELLENBERGER DEVELOPMENT PURCHASE ORDER #
78615 NAPLES DRIVE 2263
LA QUINTA, CA 92253
(760) 772-0222
(760) 772-0257 FAX
TO: Apex Interior Source November 22, 1999
86695 Avenue 54, Suite L PROJECT: Bella Vista
Coachella, CA 92236
Fax: 760/399-1103
Attention: Denise
Lot &Phase: � Lot 16, Phase 5B Ship to: 78525 Torino Drive -
Date Required ASAP La Quinta, CA '
Requested by: Rita Homeowner. Held
}. Design Center -
Qnty Ord'd
T Material / Work Required
Unit Price Total
Furnish the following upgraded window covering:
Premier verticals throughout A
$2,173.00
$2,173.00
Rio White
16) Verticals
4) Horizontals
Horizontals with Privacy '
TOTAL
$2,173.00
apecaal %.vnaIuvnsnnsuuaavns.' MUNNUVV=UUt HIVU Kt I UKr+I
Roger Snellenberger Developme t Apex Interior Source '
By:
Cc: De nt